States of Health

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This book is about relationships between a federalist political system and bioethics. It was conceived when the paramount issue about federalism in the U.S. seemed be access to care, with states refusing to access Medicaid. It was initially drafted when fifty years of federal constitutional protection for reproductive freedom seemed increasingly likely to end. And it was completed in the shadow of the Supreme Court's Dobbs decision to return abortion regulation "to the people's elected representatives" in the states. Our book explores the permissibility of differences about health, health care, and public health in a single polity of interconnected subnational units with constitutionally recognized status-that is, a federalist society. Abortion is but the tip of the iceberg of these differences, albeit a very pointed one. The federalism of the compound republic constructed by Hamilton and Madison has flexibilities and strengths but also weaknesses in dealing with moral conflicts in circumstances of injustice. These features of federalism generate ethical challenges for health care providers, their patients, and public health. A further goal of this book is to consider how providers should negotiate these challenges"--